Healthy You Health Benefits Guide 1 December 2015

Healthy You Healthy You TH E H EA LT H B E N E FITS G U I DE FO R EVE RYO N E 1 DECEMBER 2015 Laura Geitz, Australian Netball Captain

Welcome

TO QUEENSLAND COUNTRY

OU R P U R P O S E

O U R H I STO RY Queensland Country has been in the business of providing

Queensland Country Health Fund Ltd (Queensland Country)

private health insurance cover to Queenslanders for over 35

is part of a Member owned group and therefore exists to

years. Established in 1977 as the MIM Employees Health

meet the health insurance needs of Queenslanders by:

Society, the fund was developed to assist Members to protect

• I M PROVI NG TH E H EALTH AN D WE LL-B E I NG OF OU R M E M B E RS • PROVI DI NG MAR KET LEADI NG B E N E FITS • COM PETITIVE PR E M I U M S • S U PE R IOR PE RSONALI S E D G E N U I N E S E RVICE

C ONTE NTS Why private health insurance?

4

On-the-spot claiming

29

themselves against the financial burden of rising hospital and

Have existing health insurance?

6

Easy online claiming

30

ancillary health care costs. In January 1999 we began trading

Why us?

8

Manage your cover online

31

as Queensland Country Health Fund continuing the traditions

Which cover is right for you?

10

How to pay contributions

33

of affordable and comprehensive health cover backed by

Hospital cover

12

In more detail

34

superior, personalised and genuine service.

Lower your premiums with an excess!

14

Government initiatives

40

Extras cover

18

Private Health Insurance Complaints

45

Cover Packages

23

Whether you’re new to health insurance or just thinking about making a move from another insurer, give us a call to find out how exceptional benefits and genuine service makes a refreshing change!

Head office

[2]

[3]

r

alth Cove

He Lifetime

W HY I S P R IVAT E H E ALT H I N S U RAN CE

Doctor

for me?

as to when Take out hospital cover early in life to guarantee lower premiums.

With private hospital cover you can

choose your own doctor, and decide whether you will go to a public or private hospital that your doctor attends.

Whether you’re looking for yourself or your family, Queensland Country has you covered.

Hospital

Having private health insurance definitely has its rewards.

It affords you the peace of mind and the security of health

Higher income earners who take

care options and benefits simply not available today through

out hospital cover will avoid paying

the public health care system.

the Medicare Levy Surcharge.

Private hospital cover gives you the choice of being treated in either a public or private hospital with more choice over the hospital you stay in!

have long

Public System With private health insurance you avoid

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29,091

Private

*

21,921

*

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ct

*

ta

lK ne

m ov al

Su rg er

y

292 Days

HAVE TO PAY

H

100

ea

rt

200

000

[4]

309 Days

8,932

Ca

300

Queensland hospital waiting times at 90th percentile as reported by the Australian Institute of Health and Welfare, Australian Hospital Statistics 2013-2014

Re

400

428 Days

To ta

DAYS WAITI N G

500

pl

ac em en

t

public hospital waiting times!

90 Days

Queensland Country Health Fund

Some of the most common hospital procedures, if provided in a public hospital can have lengthy waiting lists. Alternatively if the medical treatment is provided in a private hospital the cost could easily be thousands of dollars if you don’t have private hospital cover. * Source Queensland Country Health Fund claims records 2014.

[5]

HAVE E X I S T I NG H EALT H I N S U RANCE?

It’s too easy to transfer!

At Queensland Country we believe Private Health Insurance should be easy to understand,

Will I need to serve any waiting periods when I switch to Queensland Country?

What we need!

If you switch from another Australian registered health

To complete the transfer to Queensland Country, you will

fund, you are guaranteed ‘portability’ of cover by law. What

be provided with a Transfer Certificate from your previous

this means is that you can transfer from one health fund to

health insurance fund.

another without having to re-serve waiting periods you’ve already served with your current fund.

This important document confirms your health cover history, your Lifetime Health Cover status, and ensures

We’ll recognise any waiting periods (or portions of waiting

you receive continuity of cover by ensuring that we apply

periods) you’ve already served if you join us within 63 days

all appropriate waiting period waivers.

of leaving your previous health fund.

If your existing health fund sends your Interfund Transfer/

easy to claim on but, most of all, it should be easy

The only time waiting periods apply when you transfer to us

Clearance Certificate to you, and not us, you’ll need to

to join or transfer to us in the first place!

from another fund is when your Queensland Country cover

forward the certificate to us.

offers a higher level of benefits than your previous cover. In this case, you’ll be entitled to the same level of benefits as you had under your previous cover until you’ve served the

Your transfer certificate is required before any benefits can be paid.

waiting period for the higher level of benefits.

If you transfer from a cover with a higher excess to one with a lower excess (for example, from a $500 excess to a $250 excess), that counts as an upgrade in your cover. In this case you may have to pay your previous higher excess until you’ve served the waiting period for the new, higher level of cover.

[6]

Join or Switch to Queensland Country today!

[7]

98%

O F R E S PO N D E N TS VO I C E D TH AT T H EY W E R E S AT I S F I E D W ITH Q U E E N S L AN D C O U N TRY

Why Us?

Source: Member Satisfaction Survey 2014

Member focused

medical practitioners throughout Australia. This ensures peace of mind and ensures that our policy holders receive maximum cover

Managing your membership online

Sponsorships and community support

At Queensland Country our primary focus is on continually

for in-hospital services within Australia, wherever they may go!

Not only can you get product information from our website,

Queensland Country is committed to supporting local

exploring ways to satisfy the needs of our policy holders.

communities, and in doing so is proud to be an official partner

As part of a Member owned group, we invest heavily in making

Adult children are also covered

but once you are a Member you can securely access and even update a range of details concerning your cover. You can do a lot

of the Women’s National Basketball League (WNBL) team -

our policy holders experience unique and refreshing.

Your adult children can remain on your family cover up to the

of things that you may normally expect to have to call us for; this

Townsville Fire, as well as Bronze sponsors of the Intrust Super

gives you greater control over your cover and gives you the ability

Cup Rugby League team - Northern Pride.

We are driven to design and deliver exceptional value private health insurance products, whilst maintaining a simpler and more satisfying experience for our growing, loyal Member base!

Happy members To ensure we maintain our high service standards, and to ensure

age of 21 years at no extra cost, and can continue to stay on their family policy up to the age of 25 years if they are studying full-time or an apprentice earning up to $30,000 p.a. and are not married or in a de-facto relationship. If they are not studying full-time or an apprentice we are able to offer our Extended Family cover option, a cost effective alternative for those families with adult dependants ensuring peace of mind for everyone. For

to update your details whenever you need to.

All you need to do is visit our website

sponsor the Townsville Running Festival, and Mackay and Bowen

www.qldcountryhealth.com.au and register with our online

Triathlon events.

services on the homepage. This will give you access to our system and you’ll be able to update a variety of details. It will take just a minute to register. For more information please

our products continually meet our policy holder’s needs, every

more information please see page 37.

see page 37.

year Queensland Country conduct a survey of its’ Members to ensure we keep touch with what our Members really think!

Home away from home!

Our own Dental Practice!

The good news is that from our last Member survey in 2014

As the majority of our policy holders live in regional and remote

we were pleased to hear that 98% of respondents voiced that

areas of Queensland, it is often necessary for people to travel to

they were satisfied with Queensland Country. We will always

Townsville or Brisbane for essential medical treatment. This can

Centre in Aitkenvale, Townsville.

strive to improve our already highly regarded reputation for

mean high accommodation expenses for family accompanying

The practice offers a full range of dental services and focuses on

exceptional Member service, to ensure our policy holders

the patient. Queensland Country has addressed this issue for

improving the oral health of Members.

always have a smile on their face!

policy holders with the purchase of a number of two bedroom

Australia-wide cover

furnished apartments in “McIlwraith on the Park” in the Brisbane

Being the only regionally based health insurer in Queensland

Pimlico, providing our Members with a home away from home.

enables us to understand the health care needs of people in this

These units are available at concessional rates for our policy

Members with Essential Extras, Young Extras or any of our

state better than anyone. However, policy holders who move,

holders exclusively for use associated with a medical need.

Hospital cover products are also eligible for treatment at

work or play interstate can also rest easy. Queensland Country in conjunction with the Australian Health Service Alliance (AHSA) have entered into an agreement with most private hospitals and [8]

suburb of Auchenflower, close to the Wesley Hospital together with “Roy Harris Place” in Townsville, near the Mater Hospital in

We are the only health fund in Australia to provide this benefit!

Backing our commitment to healthier communities we also

Queensland Country also supports local community groups through sponsorship of events and also donations. An example of this includes the RACQ NQ Rescue Helicopter.

Queensland Country Dental is Queensland Country Health Fund’s Member only dental practice located in the Queensland Country

All Health Fund Members can access high quality dental care.

Members with Premium Extras will have low or no out of pocket expenses on diagnostic and preventive treatments, including check-ups, scale and clean and mouthguards.

Queensland Country Dental at concessional prices.

For further information on the dental practice go to www.qldcountryhealth.com.au/dental [9]

Choose your level of hospital cover based on your needs and budget.

Private Hospital cover

Hospital cover

Extras cover

Description

Excess options

Top hospital

Our most comprehensive Hospital product and popular with those looking for complete peace of mind.

No excess payable.

Top hospital 250

Provides a comprehensive hospital cover where you pay the first $250 towards any inpatient hospitalisation in return for a lower premium.

$250 excess per person per membership year up to a maximum of $500 for a family policy.

Top hospital 500

Provides a comprehensive hospital cover where you pay the first $500 towards any inpatient hospitalisation in return for the lowest premium in our Top hospital cover range.

$500 excess per person per membership year up to a maximum of $1,000 for a family policy.

Provides a great value mid level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need.

$250 excess per person per membership year up to a maximum of $500 for a family policy.

Provides a great value mid level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need.

$500 excess per person per membership year up to a maximum of $1,000 for a family policy.

Description

Excess options

Public Hospital cover is exactly as the name suggests - cover in a public hospital.

Limited benefits are paid towards inpatient treatment in a private hospital.

No excess payable.

Which cover is right for you?

If you are concerned about public

If you need assistance with the cost of

hospital waiting times and want to

visits to the dentist, optometrist, physio

ensure that quality timely care is

and other health services that Medicare

available for yourself or your family

does not normally provide a benefit for,

by a doctor of your choice then

then Extras cover is for you!

one of our private hospital cover range

Intermediate hospital 250

Intermediate hospital 500

may suit you!

Public Hospital Cover

Public hospital

Choose your level of Extras cover based on your expected frequency of use and budget.

Top hospital

Top hospital 250

Premium Extras

Extras cover

Description Provides superior visit benefits for an extensive range

Top hospital 500

Intermediate hospital 250

Intermediate hospital 500

Public hospital

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Premium Extras

Essential Extras

of dental, optical and therapy services with generous annual limits.

Provides benefits for the same comprehensive range

Young Extras*

Essential Extras

of services as our Premium Extras just with slightly lower benefits and annual limits, keeping the policy cost down.

*Young Extras is the only Extras cover option that can be taken as a stand alone Extras product. All other Extras products need to be Which cover is right for you? packaged with any of our Hospital cover options.

Provides generous benefits for all the services that Young Extras

younger people generally use. Its tailor made to keep premiums low but the benefits high.

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HOS P ITAL C OVE R

WHAT YOU ARE COVERED FOR

This provides a summary of cover and isn’t intended to be a comprehensive list of all the services covered

TOP HOSPITAL COVER

NIL

EXCESS

$250

EXCESS

$500

EXCESS

INTERMEDIATE HOSPITAL COVER

$250 EXCESS

$500 EXCESS

PUBLIC HOSPITAL COVER

NIL EXCESS

Choice of Doctor/Hospital Public Hospital Accommodation as a Private Patient (Shared room, please refer to page 35.)

Private Hospital Accommodation * Theatre Fees* Surgically Implanted Prosthesis Benefits Prosthesis benefits (artificial hips, knees, etc) as per the Government listing.

Intensive Care* Medical Gap Cover for the 25% gap between the 75% Medicare Benefit and the Medicare Benefits Schedule fee for inpatient services.

Tonsils and Adenoids Removal* Appendix Removal* Colonoscopies* Grommets in Ears* Gynaecological Services* Hernia Repair* Joint Reconstructions* Back Surgery* Brain Surgery* Plastic and Reconstructive Surgery* In-hospital Rehabilitation Treatment* Rehabilitation for hospital services with restricted or excluded benefit entitlement will have reduced or nil benefit eligibility.

Obstetric Related Services* e.g. birth and pregnancy.

R

Assisted Reproductive Services* e.g. IVF.

R

In-Hospital Psychiatric Treatment* Access Gap Cover The Access Gap benefit, for inpatient services, is a benefit over and above the Medicare Benefits Schedule for participating Doctors.

▵

R

Nursing Home Type Patients* We pay a benefit toward a nursing home type patient This amount is determined by the Federal Government. Certification is required.

Cardio-Thoracic Procedures* eg. open heart surgery.

R

Major Eye Surgery* cataracts and eye lenses procedures.

R

Gastric banding, sleeving/diversions or bypass (weight loss surgery)* including replacements, repairs and adjustments.

Renal Dialysis* Hip and Knee Joint Replacement Surgery* Mechanical Appliances and Artificial Aids# Benefit up to 85% of the cost or hire of mechanical appliances and artificial aids approved by

▵ ▵

R R

Queensland Country Health with a limit of $2000 per person, per membership year.

Mammograms and Bone Density Test Benefit up to $50 limited to 2 services for each of the above tests, only if not claimable from another source.

The membership year limit is $200 per person covered.

Hearing Aids Benefit limit is provided every three (3) years with the limit amount applied based on your length of Membership with Queensland Country Health: Up to 10 years $1000, 10-15 years $1500 and 15 years+ $2000. Benefits are calculated at 85% of purchase cost up to the appropriate limit of benefit. Any hearing aid cannot be replaced within three (3) years from its original purchase date.

Australian Hearing Services Benefit of $25 per membership year per eligible person for the cost of a Hearing Services Card.

¸

Nursing Home and Bush — Benefit up to $60 per visit or $150 per day limited to $1000 per person, per membership year.

Special — Benefit of up to $150 per day $750 per person, per membership year.

Hospital Boarder Benefits up to $35 per day to a maximum of four days per person listed on the membership.

Cosmetic Surgery (hospital treatment for which Medicare pays no benefit.)

For hospital services or treatments that have Restricted benefit availability under Intermediate Hospital cover, no benefit is paid towards the cost of theatre charges raised for inpatient services in a private hospital or day surgery. If you have chosen Public Hospital cover and are an inpatient at a private hospital or day surgery, you will have a benefit entitlement to the default rate benefit only.

Benefits are not available on second hand equipment or on consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every three membership years. Waiting periods will apply to all benefits outlined. Please refer to page 40 for further details.

* Irrespective of which hospital cover you have chosen, any ancillary service provided during your hospital stay will not be able to be claimed against the fund unless you have cover for these services under an ancillary (Extras) product eg. physiotherapy, dieticians, exercise physiologists etc.

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Services we don’t pay benefits towards.

Stands for BLP - Benefit Limitation Period. Hospital benefits payable on these hospital services during the designated benefit limitation period will be the minimum benefit declared by the Minister for Health, except when a waiting period is being served, in which case no benefit applies. See Benefit Limitation Period information in this brochure.

Stands for Restricted Benefit. Covered for shared ward accommodation in a public hospital only. If you go to private hospital or day surgery for these services it is likely to result in large out-of-pocket expenses.

For more information on our hospital cover go to page 34 'In more detail'.

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LOW E R YO U R PREMIUMS

with an Excess!

AN EXCESS IS THE AMOUNT YOU AGREE TO CONTRIBUTE TOWARDS HOSPITAL COSTS IF YOU ARE ADMITTED TO A PUBLIC OR PRIVATE HOSPITAL OR A DAY SURGERY. THE MORE EXCESS YOU AGREE TO PAY, THE LOWER YOUR HEALTH MEMBERSHIP CONTRIBUTIONS WILL BE. Our private hospital cover range has flexible excess options to ensure there is an affordable cover for everyone!

Our Top Hospital cover has a choice of a nil, $250 or $500 hospital excess, whilst our Intermediate Hospital cover has only two hospital excess options of $250 or $500.

The excess is only payable if you, or someone on your policy, is admitted as an inpatient to a public hospital (as a private patient), or private hospital or a day surgery. It does not apply to Extras cover.

The excess calculation is membership year based.* The most you’ll have to pay each membership year if you choose a cover with a hospital excess is outlined below: EXCESS TYPE

SINGLES COVER

COUPLES/FAMILY/SINGLE PARENT COVER

MAXIMUM PER MEMBERSHIP YEAR

MAXIMUM PER PERSON PER MEMBERSHIP YEAR

MAXIMUM PER POLICY PER MEMBERSHIP YEAR

$250 EXCESS

$250

$250

$500

$500 EXCESS

$500

$500

$1000

With our Top hospital cover, you will not be charged an excess if your child up to and including the age of 10 years is admitted to hospital for medical treatment. This excess exemption for children 10 years and under is NOT applicable under our Intermediate Hospital cover and Singles and Couples combined cover. It is exclusive to our range of Top Hospital covers ONLY. * Membership Year is defined on page 37.

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E XTRAS

As well as Hospital cover, we also provide Ancillary cover — better known as Extras cover — which can be bundled together with your Hospital Cover.

HEALTHY LIVING BENEFITS

REWARDING LIMITS

As well as helping you to get well we want to help you to stay

Once you have held cover under either our Premium or Essential

well. Therefore we have introduced benefits to encourage you

Extras products for a year, we automatically increase your annual

to live a healthy lifestyle. We will pay up to $150 per person per

claim limits for Dental (excluding Orthodontic) and our full range

membership year to assist you to:

of Therapies by $50 per year.

*

We have three levels of Extras cover here at Queensland Country and this provides benefits for a range of general private health services that are not covered by Medicare. This includes Dental, Optical and Physiotherapy, Podiatry etc.

Participate in your choice of weight management programs

As well as looking after you if you are unwell, we also want you and your family to stay well. With our Extras cover you’ll get

We provide this loyalty incentive for the first 5 years of cover, and continue to honour this for as long as you hold cover under the

great benefits on a whole range of healthcare treatments and services and it’s a great incentive to keep that six-monthly

Participate in quit smoking programs

dental check-up, new pair of glasses or even a therapeutic massage.

Participate in other approved health management

cover on our Premium Extras product, the annual limit per person

With our three Extras Covers - Premium Extras, Essential Extras and Young Extras, you can be confident that you’ll be

programs including:

for Dental would have increased to $1650 per person per

covered from head to toe.

**

- Gym Membership

membership year.

- Personal Training programs

Loyalty limit increases do not apply to sub limits or individual

Have your skin checked for skin cancers through mole mapping

Premium Extras Essential Extras

provides you and your family with a comprehensive range of therapies and benefits with generous limits to ensure out-of-pocket expenses are kept to a minimum and can only be purchased in conjunction with a hospital cover.

Young Extras

The benefits outlined in the Health Benefits Guide are a summary of benefits payable and do not provide comprehensive details

Consultation fees for Metabolic dieticians and nutritionists

of all benefits. To confirm the details or any conditions that may

when providing assistance with weight management

apply, please contact us on 1800 813 415.

Bowel Screening tests and Bone Density tests (no doctors

can only be purchased in conjunction with a hospital cover.

referral will be required)

policy basis, and can be purchased on its own or in conjunction with a hospital cover. Young

service/item benefits.

Consultation fees for Diabetes Educator

provides a comprehensive range of therapies and benefits with lower limits and premiums and

provides a broad range of therapies and a good level of benefits with limits on a per person per

above eligible products. For example, after 5 years continuous

PSA Test (one per year). We will cover a second yearly test not covered by Medicare.

Extras is designed as an entry level extras cover and is best suited for young people under the

* Benefit payable under Premium Extras

age of 30.

** T o comply with private health insurance legislation you must have been referred by your health care professional to participate in a health management program to address, improve or prevent a specific health or medical condition. A Health Management Program Benefit Approval Form available on our website must accompany claim for these benefits.

Dental and Optical Premier Providers Queensland Country has negotiated agreements with a large number of Dental and Optical providers. Services at one of our preferred providers are well priced and are likely to reduce out of pocket expenses for Members.

Further details of these providers can be seen at www.qldcountryhealth.com.au/Understandinghealthinsurance/ Preferredprovidernetwork

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E XTRAS LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY TYPE OF SERVICE

WAITING PERIODS

DENTAL

PREMIUM EXTRAS EXAMPLE OF BENEFITS

ESSENTIAL EXTRAS

OVERALL LIMIT

EXAMPLE OF BENEFITS

YOUNG EXTRAS

OVERALL LIMIT

EXAMPLE OF BENEFITS

Diagnostic This includes examinations, consultations and Xrays etc.

2 months

eg. Periodic Oral Exam - $45 X-rays - $30

$600 sub limit^

eg. Periodic Oral Exam - $29 X-rays - $19

$400 sub limit^

eg. Periodic Oral Exam - $34 X-rays - $23

Preventative This includes cleaning and scaling, fluoride treatment and mouth guards

2 months

eg. Scale & Clean - $75 Fluoride Treatment - $22 Mouth guard - $150

$800 sub limit^

eg. Scale & Clean - $48 Fluoride Treatment - $14 Mouth guard - $96

$500 sub limit^

eg. Scale & Clean - $56 Fluoride Treatment - $17 Mouth guards - $113

Periodontics eg. Specialised Gum Treatments

12 months

$300 sub limit^

X

Simple Extraction Surgical Extractions Wisdom teeth extraction, removal of impacted teeth

2 months 12 months

*Benefits paid on dental item numbers only, unless hospital cover is held and all waits have been served for any in-patient services.

$500 sub limit^

eg. Simple Extractions - $105 Surgical Extraction - $180

$700 sub limit^

Endodontic eg. Root canal therapy and root fillings

12 months

eg. Root Canal obturation one canal - $170

$600 sub limit^

Restorative Composite fillings and amalgam fillings

2 months

eg. One surface composite filling - $90

$800 sub limit^

Crowns/Bridges

12 months

(accumulating to $1500 per year after 2 years of membership) eg.

Full Veneered Crown - $800

Prosthodontics Dentures etc.

12 months

General Services

2 months

Orthodontics Braces etc.

$1400 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^

eg. Simple Extractions - $67 Surgical Extraction - $115

$400 sub limit^

$900 overall benefit limit per person per membership year for all Dental services (excluding Orthodontics which has separate claim limits) Sub limits apply^

eg. Simple Extractions - $79 Surgical Extraction# - $135

eg. Root Canal obturation one canal - $109

$350 sub limit^

eg. One surface composite filling - $58

$500 sub limit^

$800 sub limit^

(accumulating to $1000 per year after 2 years of membership) eg. Full Veneered Crown - $512

$550 sub limit^

eg. Full Veneered Crown - $500

eg. Full upper and lower denture - $850

$850 sub limit^

eg. Full lower denture - $320

$500 sub limit^

X

eg. Occlusal splints - $300

$500 sub limit^

eg. Occlusal splints - $192

$300 sub limit^

eg. Occlusal splints - $225

X

eg. One surface composite filling - $68

OVERALL LIMIT

$500 per person up to $1,000 per policy per membership year.

Combined limit claimable for General and Major Dental (Surgical Extractions and Crowns and Bridges only)

12 months

$1000 (increasing to $2000 after completion of 2 years membership* $3000 available after completion of 3 years membership*) $3000 Lifetime limit. All limits per person. Benefits are paid at 85% of cost. *Years of membership refers to the actual period of cover on Premium Extras products only.

$500 (increasing to $1000 after completion of 2 years membership* $1500 available after completion of 3 years membership*) $1500 Lifetime limit. All limits per person.

Benefits are paid at 50% of cost. *Years of membership refers to the actual period of cover on Essential Extras products only.

No cover for Orthodontics

2 months

Total benefit for optical items or services is limited to a maximum of $275 per person, per membership year

Total benefit for optical items or services is limited to a maximum of $185 per person, per membership year

Total benefit for optical items or services is limited to a maximum of $200 per person up to $400 per policy per membership year

OPTICAL Single Vision Spectacles Bifocal Spectacles Multifocal Spectacles Contact Lenses (hard or soft) Repairs to frames/spectacle frames only/ replacement lenses

^ Dental Sub Limits: the maximum benefit amount claimable per person for treatment/service in a specific area of dentistry per membership year. This is providing an individual person’s overall dental benefit limit for the membership year has not already been reached. If this was the case no further dental benefits can be claimed by this individual on any area of dentistry until new Membership year commences. Individual dental item benefits apply.

X Service we don’t pay a benefit towards

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LIMITS PER MEMBERSHIP YEAR AND WHAT WE’LL PAY TYPE OF SERVICE

PREMIUM EXTRAS

WAITING PERIODS

THERAPIES

CONSULTATION TYPE OR SERVICE

ESSENTIAL EXTRAS OVERALL LIMIT

CONSULTATION TYPE OR SERVICE

YOUNG EXTRAS OVERALL LIMIT

CONSULTATION TYPE OR SERVICE

Acupuncture*

2 months

Initial and Subsequent - $35

Initial and Subsequent - $22

Initial and Subsequent - $30

Audiology

2 months

Initial and Subsequent - $50 Report - $60

Initial and Subsequent - $32 Report - $38

X

Chiropractic

2 months

Initial and Subsequent - $35 X-rays - $60 (not reading of x-rays)

Initial and Subsequent - $22 X-rays - $50 (not reading of x-rays)

Initial and Subsequent - $30 X-rays - $50 (not reading of x-rays)

$700 combined sub limit#

$500 combined sub limit#

Remedial Massage/Bowen Therapy/ Myotherapy*

2 months

Initial and Subsequent - $35

Osteopathy

2 months

Initial - $35 Subsequent - $35

Initial - $28 Subsequent - $24

Initial and Subsequent - $30

Naturopathy/Homeopathy*

2 months

Initial and Subsequent - $35

Initial and Subsequent - $22

Initial and Subsequent - $30

Dietitian

2 months

Initial - $75 Subsequent - $40

Initial - $48 Subsequent - $26

Initial - $55 Subsequent - $35

Occupational Therapy

2 months

Initial - $80 Subsequent - $40

Initial - $51 Subsequent- $26

X

Orthoptic Therapy

2 months

Initial and Subsequent - $60

Initial and Subsequent - $38

X

2 months

85% of cost

2 months

Initial and Subsequent - $40 Approved appliances (orthotics) 85% of cost Minor Procedures - 75% of cost

2 months

Initial - $55 Subsequent - $40 Group Therapy - $10 ($100 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology)

Foot Orthoses and Orthopaedic Shoes (orthoses and custom made footwear)

Podiatry

Physiotherapy

$150 sub limit

$600 sub limit##

Initial and Subsequent - $22

$1400 overall benefit limit per person per membership year for all Therapy services Sub limits may apply

$700 combined sub limit###

85% of cost Initial and Subsequent - $26 Approved appliances (orthotics) 85% of cost Minor Procedures - 75% of cost Initial - $36 Subsequent - $26 Group Therapy - $7 ($70 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology) Initial - $32 Subsequent - $22 Monthly Program fee - $22 Group Therapy - $7 ($70 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology)

$100 sub limit

$400 sub limit##

OVERALL LIMIT

Initial and Subsequent - $30

$900 overall benefit limit per person per membership year for all Therapy services Sub limits may apply

$300 per therapy $500 per person up to $1000 per policy

X Initial and subsequent - $30 Approved appliances (orthotics) 85% of cost up to available policy limits Minor Procedures - 75% of cost up to available policy limits

Initial - $42 Subsequent - $32 Group Therapy - $8 (sub limit of $80 applies)

$400 per person up to $800 per policy

$500 combined sub limit###

Exercise Physiology

2 months

Initial - $50 Subsequent - $35 Monthly Program fee - $35 Group Therapy - $10 ($100 combined sub limit applies for Group therapy services provided under Physiotherapy and/or Exercise Physiology)

Psychology

2 months

Initial and Subsequent - $80 Report - $80 Group Therapy - $80

Initial and Subsequent - $51 Report - $51 Group Therapy - $51

X

Speech Therapy

2 months

Initial - $70 Subsequent - $35

Initial - $45 Subsequent - $22

X

X

OTHER EXTRAS Childbirth Education

12 months

$60

$38

X

Pharmaceutical^^

2 months

Up to $50 Limit of $500 per person per membership year

Up to $30 Limit of $300 per person per membership year

Up to $30 Limit of $150 per person up to $300 per policy per membership year

School Accidents

2 months

100% - Limit of $750 per dependent child per membership year

100%- Limit of $450 per dependent child per membership year

X

Healthy Living (see Healthy Living benefits information on previous page 17)

2 months

$150 per person per membership year

$125 per person per membership year

$125 per person up to $250 per policy per membership year

^^ Prescriptions not covered by the PBS, excluding contraceptives and items normally available without prescription and drugs not approved for sale in Australia. A co-payment applies to each prescription item equal to the current PBS General Patient Contribution. Please refer to page 42 for more information. # Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Chiropractic, Remedial Massage/ Bowen Therapy/ Myotherapy and Osteopathic services. Group Therapy has a combined sub limit for services provided under Physiotherapy and Exercise Physiology. This is providing an individual person’s overall Therapies benefit limit for the membership year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership year commences. Individual visit benefits apply. ## Sub limits: the maximum benefit amount claimable per person per membership year for Podiatry services. This is providing an individual person’s overall therapies benefit limit for the membership year has not already been reached. If this was the case no further benefits can be claimed on this,or any therapy until new Membership year commences.

[ 20 ]

### Combined Sub limit: the maximum benefit amount claimable per person per membership year for a combination of Physiotherapy and Exercise Physiology services. This is providing an individual person’s overall Therapies benefit limit for the membership year has not already been reached. If this was the case no further therapy benefits can be claimed by this individual on any therapy until new Membership year commences.

Individual visit benefits apply. There are specific requirements to claim for Exercise Physiology. Contact the Fund for details. * Benefits are payable for services rendered by Australian Regional Health Group approved providers registered with Queensland Country as well as Bowen Therapists that are registered with the Bowen Association of Australia (BAA) or Bowen Therapists Foundation of Australia (BT FA).

Membership Year limits are calculated from the anniversary date of the establishment of the policy.

X Service we don’t pay a benefit towards

[ 21 ]

C OVE R PACKAG E S We provide our policyholders with a simple, but flexible product range, allowing a choice of health cover to meet any budget or need To keep it simple and easy to understand you can choose one of our three broad hospital cover options – Top, Intermediate or Public. You then select an eligible excess option that you are comfortable with, and that’s your hospital cover locked in!

Then if you wish you can add an Extras cover that best suits you or your family’s needs! Choose between our Premium, Essential or Young Extras covers.

You can even take Young Extras as a stand-alone product.

It’s that simple!

[ 22 ]

[ 23 ]

Couple/Family cover

S i ngles cover SINGLE HOSPITAL PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL

MONTHLY

YEARLY

$$32.80

$$142.20

$$1,706.65

TOP HOSPITAL 250

$$29.45

$$127.80

TOP HOSPITAL 500

$$25.95

INTERMEDIATE HOSPITAL 250

NO REBATE DEDUCTED MONTHLY

YEARLY

$$45.45

$$197.05

$$2,364.45

$$1,534.00

$$40.85

$$177.10

$$2,125.25

$$112.50

$$1,349.65

$$35.95

$$155.85

$$1,869.90

$$19.65

$$85.15

$$1,022.00

$$27.25

$$118.00

$$1,415.95

INTERMEDIATE HOSPITAL 500

$$16.70

$$72.60

$$871.50

$$23.20

$$100.60

$$1,207.45

PUBLIC HOSPITAL

$$17.55

$$76.10

$$913.55

$$24.35

$$105.45

$$1,265.70

SINGLE HOSPITAL + EXTRAS PREMIUMS

PRODUCT

WITH BASE TIER REBATE WEEKLY

MONTHLY

TOP HOSPITAL + PREMIUM EXTRAS

$$43.90

$$190.35

TOP HOSPITAL + ESSENTIAL EXTRAS

$$39.20

TOP HOSPITAL + YOUNG EXTRAS

YEARLY

WEEKLY

NO REBATE DEDUCTED WEEKLY

MONTHLY

YEARLY

$$2,284.25

$$60.85

$$263.75

$$3,164.70

$$170.05

$$2,040.70

$$54.35

$$235.60

$$2,827.25

$$37.75

$$163.60

$$1,963.35

$$52.30

$$226.70

$$2,720.10

TOP HOSPITAL 250 + PREMIUM EXTRAS

$$40.60

$$175.95

$$2,111.60

$$56.25

$$243.80

$$2,925.50

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$$35.90

$$155.65

$$1,868.05

$$49.75

$$215.65

$$2,588.05

TOP HOSPITAL 250 + YOUNG EXTRAS

$$34.40

$$149.20

$$1,790.70

$$47.70

$$206.75

$$2,480.90

TOP HOSPITAL 500 + PREMIUM EXTRAS

$$37.05

$$160.55

$$1,927.35

$$51.35

$$222.50

$$2,670.20

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$$32.35

$$140.30

$$1,683.70

$$44.85

$$194.40

$$2,332.70

TOP HOSPITAL 500 + YOUNG EXTRAS

$$30.85

$$133.85

$$1,606.40

$$42.80

$$185.45

$$2,225.60

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$$30.70

$$133.30

$$1,599.65

$$42.60

$$184.70

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$$26.10

$$112.95

$$1,356.05

$$36.15

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$$24.55

$$106.55

$$1,278.75

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$$27.85

$$120.75

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$$23.15

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

COUPLE/FAMILY HOSPITAL PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL

MONTHLY

YEARLY

$$65.65

$$284.40

$$3,412.90

TOP HOSPITAL 250

$$59.00

$$255.70

TOP HOSPITAL 500

$$51.90

INTERMEDIATE HOSPITAL 250

NO REBATE DEDUCTED MONTHLY

YEARLY

$$90.95

$$394.05

$$4,728.35

$$3,068.35

$$81.75

$$354.25

$$4,251.00

$$224.95

$$2,699.75

$$71.95

$$311.70

$$3,740.35

$$39.25

$$170.15

$$2,042.15

$$54.40

$$235.75

$$2,829.30

INTERMEDIATE HOSPITAL 500

$$33.50

$$145.20

$$1,742.65

$$46.45

$$201.20

$$2,414.35

PUBLIC HOSPITAL

$$35.10

$$152.20

$$1,826.75

$$48.65

$$210.90

$$2,530.85

COUPLE/FAMILY HOSPITAL + EXTRAS PREMIUMS

PRODUCT

WITH BASE TIER REBATE MONTHLY

TOP HOSPITAL + PREMIUM EXTRAS

$$87.80

$$380.70

TOP HOSPITAL + ESSENTIAL EXTRAS

$$78.50

TOP HOSPITAL + YOUNG EXTRAS

YEARLY

NO REBATE DEDUCTED WEEKLY

MONTHLY

YEARLY

$$4,568.60

$$121.70

$$527.45

$$6,329.45

$$340.05

$$4,081.00

$$108.75

$$471.15

$$5,653.95

$$75.45

$$327.20

$$3,926.75

$$104.60

$$453.35

$$5,440.25

TOP HOSPITAL 250 + PREMIUM EXTRAS

$$81.20

$$351.95

$$4,224.05

$$112.55

$$487.65

$$5,852.10

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$$71.85

$$311.35

$$3,736.45

$$99.55

$$431.40

$$5,176.60

TOP HOSPITAL 250 + YOUNG EXTRAS

$$68.90

$$298.45

$$3,582.20

$$95.45

$$413.55

$$4,962.90

TOP HOSPITAL 500 + PREMIUM EXTRAS

$$74.10

$$321.25

$$3,855.45

$$102.70

$$445.10

$$5,341.45

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$$64.75

$$280.60

$$3,367.85

$$89.75

$$388.80

$$4,665.95

TOP HOSPITAL 500 + YOUNG EXTRAS

$$61.75

$$267.75

$$3,213.60

$$85.60

$$371.00

$$4,452.25

$$2,216.25

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$$61.50

$$266.45

$$3,197.85

$$85.20

$$369.20

$$4,430.40

$$156.55

$$1,878.75

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$$52.10

$$225.85

$$2,710.25

$$72.20

$$312.90

$$3,754.90

$$34.05

$$147.65

$$1,771.65

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$$49.15

$$213.00

$$2,556.00

$$68.10

$$295.10

$$3,541.20

$$1,449.15

$$38.60

$$167.30

$$2,007.70

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$$55.70

$$241.50

$$2,898.35

$$77.20

$$334.60

$$4,015.45

$$100.45

$$1,205.55

$$32.10

$$139.20

$$1,670.25

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$$46.35

$$200.90

$$2,410.75

$$64.25

$$278.35

$$3,339.95

$$21.65

$$94.00

$$1,128.20

$$30.05

$$130.25

$$1,563.10

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

$$43.35

$$188.00

$$2,256.50

$$60.10

$$260.50

$$3,126.25

PUBLIC HOSPITAL + PREMIUM EXTRAS

$$28.70

$$124.25

$$1,491.20

$$39.75

$$172.15

$$2,065.95

PUBLIC HOSPITAL + PREMIUM EXTRAS

$$57.30

$$248.50

$$2,982.40

$$79.45

$$344.30

$$4,131.90

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$$24.00

$$103.95

$$1,247.60

$$33.25

$$144.05

$$1,728.50

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$$47.95

$$207.90

$$2,494.85

$$66.45

$$288.05

$$3,456.45

PUBLIC HOSPITAL + YOUNG EXTRAS

$$22.50

$$97.50

$$1,170.25

$$31.20

$$135.10

$$1,621.35

PUBLIC HOSPITAL + YOUNG EXTRAS

$$45.00

$$195.00

$$2,340.55

$$62.35

$$270.20

$$3,242.70

YOUNG EXTRAS

$$4.95

$$21.40

$$256.75

$$6.85

$$29.65

$$355.70

YOUNG EXTRAS

$$9.85

$$42.80

$$513.85

$$13.70

$$59.30

$$711.90

[ 24 ]

WEEKLY

WEEKLY

[ 25 ]

Single Parent cover SINGLE PARENT HOSPITAL PREMIUMS

Extended Family Cover WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL

NO REBATE DEDUCTED

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

$$3,781.95

TOP HOSPITAL + PREMIUM EXTRAS

$$111.55

$$483.50

$$5,802.30

$$154.60

$$669.90

$$8,038.70

$$283.25

$$3,399.25

TOP HOSPITAL + ESSENTIAL EXTRAS

$$99.65

$$431.95

$$5,184.15

$$138.10

$$598.50

$$7,182.25

$$57.50

$$249.20

$$2,990.50

TOP HOSPITAL 250 + PREMIUM EXTRAS

$$103.10

$$446.95

$$5,363.90

$$142.90

$$619.25

$$7,431.30

$$2,042.15

$$54.40

$$235.75

$$2,829.30

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$$91.25

$$395.45

$$4,745.75

$$126.45

$$547.90

$$6,574.90

$$145.20

$$1,742.65

$$46.45

$$201.20

$$2,414.35

TOP HOSPITAL 500 + PREMIUM EXTRAS

$$94.05

$$407.55

$$4,890.95

$$130.30

$$564.65

$$6,776.10

$$152.20

$$1,826.75

$$48.65

$$210.90

$$2,530.85

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$$82.15

$$356.05

$$4,272.80

$$113.85

$$493.30

$$5,919.70

MONTHLY

YEARLY

$$52.50

$$227.45

$$2,729.80

$$72.75

$$315.15

TOP HOSPITAL 250

$$47.15

$$204.40

$$2,453.55

$$65.35

TOP HOSPITAL 500

$$41.50

$$179.85

$$2,158.50

INTERMEDIATE HOSPITAL 250

$$39.25

$$170.15

INTERMEDIATE HOSPITAL 500

$$33.50

PUBLIC HOSPITAL

$$35.10

WITH BASE TIER REBATE WEEKLY

MONTHLY

TOP HOSPITAL + PREMIUM EXTRAS

$$74.70

$$323.80

TOP HOSPITAL + ESSENTIAL EXTRAS

$$65.35

TOP HOSPITAL + YOUNG EXTRAS

YEARLY

WEEKLY

NO REBATE DEDUCTED WEEKLY

MONTHLY

$$3,885.45

$$103.50

$$448.60

$$5,383.05

$$283.15

$$3,397.90

$$90.55

$$392.30

$$4,707.55

$$62.35

$$270.30

$$3,243.65

$$86.40

$$374.50

$$4,493.85

TOP HOSPITAL 250 + PREMIUM EXTRAS

$$69.40

$$300.75

$$3,609.20

$$96.15

$$416.70

$$5,000.30

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$$60.00

$$260.10

$$3,121.65

$$83.15

$$360.40

$$4,324.85

TOP HOSPITAL 250 + YOUNG EXTRAS

$$57.05

$$247.25

$$2,967.35

$$79.05

$$342.60

$$4,111.10

TOP HOSPITAL 500 + PREMIUM EXTRAS

$$63.70

$$276.20

$$3,314.20

$$88.30

$$382.65

$$4,591.60

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$$54.35

$$235.55

$$2,826.60

$$75.30

$$326.35

$$3,916.10

TOP HOSPITAL 500 + YOUNG EXTRAS

$$51.35

$$222.70

$$2,672.35

$$71.20

$$308.55

$$3,702.40

INTERMEDIATE HOSPITAL 250 + PREMIUM EXTRAS

$$61.50

$$266.45

$$3,197.85

$$85.20

$$369.20

$$4,430.40

INTERMEDIATE HOSPITAL 250 + ESSENTIAL EXTRAS

$$52.10

$$225.85

$$2,710.25

$$72.20

$$312.90

$$3,754.90

INTERMEDIATE HOSPITAL 250 + YOUNG EXTRAS

$$49.15

$$213.00

$$2,556.00

$$68.10

$$295.10

$$3,541.20

INTERMEDIATE HOSPITAL 500 + PREMIUM EXTRAS

$$55.70

$$241.50

$$2,898.35

$$77.20

$$334.60

$$4,015.45

INTERMEDIATE HOSPITAL 500 + ESSENTIAL EXTRAS

$$46.35

$$200.90

$$2,410.75

$$64.25

$$278.35

$$3,339.95

INTERMEDIATE HOSPITAL 500 + YOUNG EXTRAS

$$43.35

$$188.00

$$2,256.50

$$60.10

$$260.50

$$3,126.25

PUBLIC HOSPITAL + PREMIUM EXTRAS

$$57.30

$$248.50

$$2,982.40

$$79.45

$$344.30

$$4,131.90

PUBLIC HOSPITAL + ESSENTIAL EXTRAS

$$47.95

$$207.90

$$2,494.85

$$66.45

$$288.05

$$3,456.45

PUBLIC HOSPITAL + YOUNG EXTRAS

$$45.00

$$195.00

$$2,340.55

$$62.35

$$270.20

$$3,242.70

YOUNG EXTRAS

$$9.85

$$42.80

$$513.85

$$13.70

$$59.30

$$711.90

[ 26 ]

NO REBATE DEDUCTED

WEEKLY

YEARLY

PRODUCT

WITH BASE TIER REBATE

PRODUCT

MONTHLY

SINGLE PARENT HOSPITAL + EXTRAS PREMIUMS

EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS

YEARLY

SINGLE PARENT EXTENDED FAMILY HOSPITAL + EXTRAS PREMIUMS

WITH BASE TIER REBATE

PRODUCT

WEEKLY

TOP HOSPITAL + PREMIUM EXTRAS

NO REBATE DEDUCTED

MONTHLY

YEARLY

WEEKLY

MONTHLY

YEARLY

$$94.90

$$411.30

$$4,935.65

$$131.50

$$569.85

$$6,838.00

TOP HOSPITAL + ESSENTIAL EXTRAS

$$83.05

$$359.75

$$4,317.45

$$115.05

$$498.45

$$5,981.55

TOP HOSPITAL 250 + PREMIUM EXTRAS

$$88.15

$$381.95

$$4,583.95

$$122.15

$$529.20

$$6,350.75

TOP HOSPITAL 250 + ESSENTIAL EXTRAS

$$76.25

$$330.45

$$3,965.75

$$105.65

$$457.85

$$5,494.30

TOP HOSPITAL 500 + PREMIUM EXTRAS

$$80.85

$$350.50

$$4,206.00

$$112.05

$$485.60

$$5,827.10

TOP HOSPITAL 500 + ESSENTIAL EXTRAS

$$69.00

$$298.95

$$3,587.85

$$95.60

$$414.20

$$4,970.70

[ 27 ]

WE BELIEVE THAT CLAIMING BENEFITS SHOULD BE QUICK & EASY

so you’ve got more time to relax and enjoy life!

On-the-spot claiming for extras To make it even easier to claim

Depending on your level of cover, and

your benefit, participating health

if your provider has the appropriate

professionals have electronic claiming

facility, you can claim these services

facilities available.

through HICAPS:

HICAPS/IBA allows you to simply

Dentists, Endodontists,

swipe your Queensland Country

Periodontists, Dental Prosthetist/

Membership Card at the end of your

Advanced Dental Technicians,

consultation or treatment, automatically

Prosthodontists, Paediatric Dentists

deducting your benefit entitlement from the amount you’ve been charged. Then, all you have to pay is

Optical Dispensers

the difference.

Physiotherapists

By using electronic claiming you don’t

Chiropractors

have to lodge a manual claim, so no

Osteopaths

need to fill out a claim form and no waiting for the claim to be processed.

To find out if your health service provider has HICAPS visit them online at www.hicaps.com.au

[ 28 ]

Dispensing Optometrists,

Podiatrists Occupational Therapists Psychologists Massage Therapy

[ 29 ]

Easy Online Claiming!!

Save time and get your money back even faster - online claiming is now available!

We’ve now made it even easier to claim

Dietetics Homeopathy

M assage

Online Member Services (OMS)

Below is a list of all the different

gives you the ability to update your

services you can access by registering:

membership details whenever you want, giving you greater control and

Claims history

for a wide range of services when on-

Naturopathy

easy access.

View/print tax statement

the-spot claiming isn’t available through

Occupational Therapy

You can log on at any time of the day

Update Membership details

your provider. Simply go online using

O ptical

and check your cover; update address

Change contact details

Osteopathy

even add a new addition to the family.

Physiotherapy

To access OMS, all you need to do is

your PC, tablet or smart phone!

Log in to Online Member Services where you will find instructions on how to submit your claim, it’s really easy!!

Podiatry consultations only –

You can claim up to $400 per day in

No benefit for Orthotics

benefits for services up to three (3)

and/or appliances payable via

months from the actual date of the

Online claiming

service, treatment or visit*.

The following services# can be claimed online, depending on your level of cover Acupuncture Audiology Chiropractor Dental – General services only.

NO major dental or Orthodontic

details, change your level of cover and

Add new person Change personal details

register on the homepage of our website

A dd student dependant

www.qldcountryhealth.com.au. The

or apprentice

“register” icon is located at the top right hand corner of the screen. Once you

Add Medicare card details

have registered using your membership

Add previous cover details

Psychology

number and your choice of password, click on the Login tab and enter your

M ake a contribution payment by

Speech Therapy

membership number and password. * Eligible benefits are only claimable after 3 months of membership with the fund. # Some of these services are not available on Young Extras cover.

Receipts are not required to be submitted with your online claim, however we may request them for review and ask that you keep your receipts for twelve (12) months from the date of claiming.

Full terms and conditions for online claiming can be found on our website www.qldcountryhealth.com.au/members/claims

[ 30 ]

Manage your cover online

Now you’re ready to go!

credit card Update your method of payment

NB. Access to some functions may

Change level of cover

be limited for your spouse/partner

Update the way we pay benefits

and dependants.

eg. direct credit Contribution changes View benefit limits

[ 31 ]

HOW TO PAY C ONTR I B UTION S Queensland Country offers you a variety of payment options so you can choose the best method for you. You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. If you choose to pay by a method other than direct debit from a bank account or credit card, and your payment frequency is quarterly or greater, we will send you a reminder notice as a courtesy.

As a policy holder it is your responsibility to ensure that the payment amounts are correct and made in advance, this avoids claims being rejected due to an un-financial status.

Your policy will commence from a future date that you nominate or simply the date that your application is received by us or Queensland Country Credit Union. We will then forward a membership card to your address.

Direct Debit

Credit Card

BPAY

BillPaying

Direct Debit facilities are

Credit Card* facilities are

BPAY facilities are available

BillPaying Service —

available for policy holders

available to all policy holders

to all policy holders who

Queensland Country Credit

who prefer to pay through

who prefer to pay via this

prefer to pay via this option.

Union offers a BillPaying

automatic deductions from

option. If this is your preferred

BPAY allows you to pay your

service through all their

their Bank, Building Society,

method of payment, simply

health insurance premium via

branch offices. BillPaying is

Credit Union accounts

visit our website and make

internet or phone banking, or

a comprehensive budgeting

and Credit Cards. If this is

the payment online through

at your financial institution.

and bill paying service that

your preferred method of

Online Member Services

The BPAY biller code and

provides a fast and simple

payment, simply nominate

(OMS^). Alternatively, visit

your reference number

way to pay all your bills. If you

this on the application form,

one of our Retail Centres

appear on all statements.

would like more information

and complete your details or

located in Townsville,

If you don’t receive regular

on this service, please feel

visit our website. A reminder

Mount Isa, Ayr Mackay and

statements please contact us

free to contact Queensland

notice is not issued if you pay

Gladstone. Details appear at

and we’ll be happy to supply

Country Credit Union on

by direct debit.

the back of this brochure, or

you with your BPAY biller

1800 075 078.

phone us on 1800 813 415.

code and reference number.

* We do not accept American Express

(This option is not available

or Diners Club

^ Please see page 30 for details on how to register for OMS

to eligible participants in a Corporate Health Plan)

Note: Deadlines may exist for one or more of these payment options.

Please consult our Membership Guide for further details.

You can choose to pay weekly, fortnightly, monthly, quarterly, 6 monthly or yearly, whichever suits you. [ 32 ]

[ 33 ]

EXCLUDED BENEFITS An excluded service means you will not be covered in a public or

ACCESS GAP - MINIMISE OUT-OFPOCKET EXPENSES

private hospital and will not receive a payment from Queensland

Access Gap is a major feature of our hospital cover.

Country for that service. If you think you may require treatment

Participation by your doctor in Access Gap could significantly

for any excluded services you may like to consider taking one of

reduce medical costs for inpatient hospital services, or in some

our Top Hospital cover products.

cases, may eliminate them completely.

Membership guide

However, should you wish to have full benefit entitlement for any

By making arrangements with your doctor before going into

of the restricted or excluded services under our Intermediate

hospital you will have an understanding of the costs for the

Hospital cover, you will need to upgrade your policy to one of

medical procedure based on how the doctor will charge for

We have prepared a Membership Guide to outline a summary of the rules that apply to your membership.

Please ask for a Membership Guide or access it by visiting us at www.qldcountryhealth.com.au. It should be read in conjunction with this Health Benefits Guide.

our Top Hospital cover options at least 12 months in advance to

their services.

provide cover for hospital services that are listed as Restricted or

Under this direct billing arrangement Queensland Country

Excluded services.

will pay a higher amount to your doctor if he or she agrees to

I N MOR E DETAI L...

PUBLIC HOSPITAL COVER

Hospital Benefits

participate and charge you fees in accordance with the agreement.

Public Hospital cover is exactly as the name suggests -

If your doctor agrees, it means that they are willing to accept

cover for treatment in a public hospital.

TOP HOSPITAL COVER

a set fee for their services that is more than the MBS fee, and

Public Hospital cover is a basic level of hospital cover designed

means you are likely to have lower out-of-pocket costs, and in

Queensland Country’s most comprehensive Hospital product and popular with those looking for complete peace of mind. Covering you

for those who want to be treated as a private patient in a public

some cases, none at all!

hospital. This cover option will allow you or your family to choose

Participation by your doctor in Access Gap is voluntary. There is

your own doctor (if he/she is willing, or able to treat you in a

no obligation to do so.

for a complete range of hospital services including Pregnancy, Heart related procedures, Major eye surgery and Joint Replacement surgery. Top Hospital can be taken on its own or packaged with any of our Extras packages. You can reduce your premiums by paying an excess when admitted to hospital you have a choice of $0, $250 or $500.

public facility) and receive treatment as a private patient in a

BENEFIT LIMITATION PERIODS

INTERMEDIATE HOSPITAL COVER

ward accommodation only up to the level prescribed by the Federal Minister for Health, if admitted as a private patient. So if

You can search for doctors who may participate in the Access

Our Top Hospital cover requires a policy holder (who is new to

A great value mid-level hospital cover ideal for a young or healthy person who doesn’t want to pay for hospital services they feel less inclined to need like Pregnancy, IVF, Heart Surgery, Major Eye surgery, Renal Dialysis, in hospital Psychiatric care or even a Hip or Knee replacement. A very cost effective option if you want comprehensive cover for the vast majority of hospital treatments and are prepared to have limited or no cover for the Restricted or Excluded services under this cover.

you choose to be admitted in a private room in a public hospital,

Gap Scheme by referring to the AHSA website https://www.

you will incur further out-of-pocket expenses.

ahsa.com.au/web/gapcoversearch

However public hospital cover will not assist in avoiding waiting

We also recommend that you contact us before going into

times in the public hospital system, and would also mean that if

hospital or day surgery so that we can discuss the level of benefit

you require to be treated in a private hospital or day surgery you

your policy provides you.

private health insurance hospital cover) to be with Queensland Country for a period of 24 months before certain hospital services are fully covered. Benefit Limitation Periods will apply to the following services: ·B ariatric Surgery (weight loss surgery): including but not limited to gastric banding; gastric sleeving/diversion; and gastric bypass surgery; including replacement, repair or adjustments. · Hip or Knee Joint Replacement Surgery: during the first 24 months of cover (but after the standard hospital waiting periods have been served), benefits payable for these services will be limited to restricted benefits. · In-Hospital Psychiatric Treatment: during the first 24

RESTRICTED BENEFITS If a service is covered as a Restricted Benefit, this means you will be covered with your choice of doctor for shared ward accommodation in a public hospital only. If you go to a private hospital for a specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses.

public hospital. This means we will pay for the cost of shared

if you were to choose one of our Private Hospital cover options.* * Some hospital services under our Intermediate Hospital cover have restricted or excluded benefit entitlement however. Please see Hospital Cover table for details of these restrictions and exclusions.

REDUCE YOUR MEDICAL COSTS

MBS fee for your medical expenses. Queensland Country will

can result in significant out-of- pocket expenses. Queensland

Benefit Limitation Periods will not apply if you are

Whilst cover with Restricted Benefits entitles you to your choice of Doctor in a public hospital, your Doctor may not be willing, or able, to treat you in a public facility.

transferring from another health fund’s hospital cover

Waiting periods may also apply to all restricted services.

Restricted benefits will only cover you for a stay in a shared ward of a public hospital. But it will not cover the cost for a stay in a private room in a public hospital or a stay in a private hospital, you will incur large out-of-pocket expenses to cover the difference in costs.

providing you are transferring within 63 days of ceasing

OUR BENEFIT 25%

OUR BENEFIT

OUT-OF-POCKET

(MEDICAL GAP)

(ACCESS GAP)

EXPENSES

MEDICARE BENEFIT SCHEDULE (MBS) FEE

ACCESS GAP

YOU R D O CTO R ’ S F E E

services separately to your hospital accommodation costs. Their

Not every hospital cover product has benefit restrictions, please refer to hospital cover tables on pages 12-13 to determine benefit entitlement conditions for individual hospital products.

will be limited to restricted benefits.

MEDICARE REBATE 75%

Your doctor, surgeon and anaesthetist, will all charge for their fees are known as medical expenses. These medical expenses

periods have been served) benefits payable for these services

expenses you will have to meet before you go to hospital.

will face high out-of-pocket expenses, which may not be the case

Restricted Benefits are amounts set by the Government and are generally not enough to cover accommodation costs in a private hospital. No benefit is paid towards the cost of theatre charges raised for services in a private hospital.

months of cover (but after the standard hospital waiting

Your doctor must inform you of the total of any out-of-pocket

are assessed against the Medicare Benefits Schedule (MBS) fees, which are set down by the government. If you are admitted to hospital as a private patient. Medicare will pay 75% of the pay the remaining 25% of the MBS fee.

However, some doctors charge more than the MBS fee. This Country’s private hospital cover can help reduce or avoid these extra expenses through our Access Gap agreement.

the previous cover. [ 34 ]

[ 35 ]

PRE-EXISTING CONDITIONS

HOSPITAL NETWORK

MEMBERSHIP YEAR

A pre-existing ailment, illness or condition is one where, after

Queensland Country has negotiated Purchaser Provider

All yearly limits and excesses are calculated from the anniversary

examining evidence, a medical adviser, or other relevant health

Agreements with most of the participating private hospitals and

date of the establishment of the membership.

care practitioner appointed by Queensland Country would

day hospital facilities Australia-wide. In most instances, the

consider that signs or symptoms would have been in existence

approved hospital charges for policy holders of a Top Hospital

at any time during the six months preceding the application for

policy will be covered in full once the agreed excess has been

membership or upgrade of cover. You may have a pre-existing

deducted. This means that you will benefit from capped fees

condition, ailment or illness without being aware of it. In these

we’ve negotiated and convenient billing as your invoice will be

cases, there is a 12 month waiting period before you are entitled

sent directly to Queensland Country.

to claim benefits for treatment. It is not necessary for the

Private hospitals and day hospital facilities that have not signed

signs or symptoms to have been diagnosed by a doctor when a member joined or upgraded their level of cover.

an agreement attract reduced benefits which will mean you may

Types of Memberships Singles, Couples & Families Single: a single policy covers only one person.

incur out-of-pocket medical expenses for in-hospital treatment.

Couple: a couple policy covers the person who establishes

Surgery for assisted fertility programs such as IVF or GIFT,

Go to our website to find a hospital most convenient to you.

the policy as well as that person’s partner. The policy can be

Sterilisation or Vasectomy are elective and attract a 12 month

www.qldcountryhealth.com.au

waiting period as does obstetrics-related services.

extended to cover dependant children at no additional cost.

Family: a family policy covers the person who establishes the

The 12 month pre-existing condition waiting period can

BENEFIT CONDITIONS

policy as well as that person’s partner and all dependant children

be applied to all hospital or hospital substitute treatment

Queensland Country will only pay benefits when:

covered up to age 25*.

for which we pay benefits. However, a two month waiting period applies to the following services:

Goods and Services are provided in Australia

a pproved psychiatric treatment

T he Member has been charged for the treatment or service

a pproved rehabilitation treatment, or

A service or treatment is medically necessary and clinically

p alliative care.

relevant

(up to 21 years). Student and apprentice dependants can be

Single Parent Family: a single parent family policy covers the person who establishes the policy as well as that person’s dependant children (up to 21 years). Student and apprentice

Condition can also apply to ancillary (Extras) services.

Queensland Country

PROSTHESIS BENEFIT

The service is provided in person

In the case of a single parent family, the Extended Family policy

The service is provided to a person on the membership

will cover the person who establishes the policy as well as that

MECHANICAL APPLIANCES AND AIDS To help you maintain your health we provide an excellent benefit on our Top Hospital cover of up to 85% of the cost of mechanical

The service or treatment has been provided by a practitioner or therapist recognised by Queensland Country

T he treatment or service is covered under the Member’s level of cover No benefits are payable from another source (e.g.

appliances and artificial aids approved by Queensland Country

compensation payment or Government benefit)

within a membership year limit of $2,000 per person covered.

The conditions of the level of cover have been met

For some mechanical aids the benefit is for hire only. Products covered include: Blood Pressure Monitor, Glucometer, Tens Machine, crutches, walking frame, wigs etc.

Benefits are not available on second hand equipment or on

A claim for a service rendered is submitted for payment within 24 months of the date of service The waiting period for that service has been served

consumables. A benefit is payable for short term hiring (up

The benefit limitation period for that service has been served

to 3 months) of some mechanical aids. The purchase of some

(where applicable)

machines & monitors are limited to once every three years from the date of purchase.

The amount of benefit is calculated on the cost of the treatment or aid to the Member, taking into account any

A letter of referral from your doctor or other practitioner may be

allowances or discounts given by the provider. No benefit paid by

required. Please contact us regarding benefit availability prior to

Queensland Country can exceed the actual charge of the service

purchasing an aid or appliance.

or appliance.

Mechanical Appliances and Aids coverage is not available on our Intermediate Hospital or Public Hospital cover products

I s not married or living in a de facto relationship If, at any time, your student dependant’s situation changes and they no longer meet all the above conditions then please contact us for further information.

Covering adult children Extended Family cover# will allow all adult children between 21 & 25 years to remain on their family or single parent policy (as long as they are not married or in a de facto relationship).

The Extended Family cover policy premium will of course be higher than our standard family or single parent family policy, but will prove to be a financially more economical option for eligible dependant children, in comparison to having them take out their own cover at an equivalent level. # Extended Family cover option will be restricted to Top Hospital and Premium Extras or Essential Extras packaged covers only. It will not be available to family or single parent policies with any Hospital Only Product, Intermediate Hospital, or Intermediate Hospital and Extras package, Private Hospital and Young Extras Product, Singles and Couples Combined cover Products or Public Hospital and Extras packaged covers.

Extended Family^^: a family policy option which covers the

Services are part of a course of treatment recognised by

and other items on the Federal Government prostheses list.

not earn more than $30,000 p.a;

dependants can be covered up to age 25*.

The 12 month waiting period for the treatment of a pre-existing

We provide a benefit towards surgically implanted prostheses

I s an apprentice who is not aged 25 years or over and does

person who establishes the policy as well as that person’s partner and all dependant children up to the age of 25* years.

person’s dependant children up to the age of 25* years. * As long as the dependant child is not married or living in a de facto relationship ^^ Only Top Hospital and Premium/Essential Extras Packaged covers are available for Extended Family policies. Not available for any Hospital only cover, Extras only covers, packaged Top Hospital and Young Extras; or Public Hospital and Extras covers.

Dependants Dependants include a policy holder’s children and stepchildren, legally adopted children or foster children under the age of 21.

Dependants turning 21 who are not eligible for cover under a family policy as a student or apprenticeship dependant are required to commence their own policy if they wish to continue private health cover. The good news is that they can move straight across to their own single membership without having to serve any waiting periods.

Alternatively, dependants between 21 & 25 years who do not qualify as a student or apprentice dependant may stay on your family policy for an additional premium. Please refer to the section “Covering Adult Children”.

Dependants will be covered as student dependants under their parent’s membership from 21 years of age up to 25 years of age, provided the following conditions are satisfied:

I s a full time student at a school, college or university who is not aged 25 years or over; or

[ 36 ]

[ 37 ]

WAITING PERIODS So when will I be fully covered you ask? Waiting periods apply when you join any health fund for the very first time or when you upgrade to a higher level of cover. But you won’t have to wait if you’re transferring to Queensland Country from an equivalent or higher level of cover with another health fund, or if you’ve been covered by your parents’ membership and you’re just starting out on your own. For full details, please refer to our Membership Guide under the heading “Transferring from another Fund”.

Waiting periods are necessary to keep health cover fair and aim to protect our existing policy holders who contribute to a fund over a period of time for when they may need cover. If we didn’t have these waiting periods people may join, claim for something planned and then leave. Always make sure you have waited the sufficient period before claiming, otherwise you may not be covered!

Waiting period

CONTRIBUTIONS IN ARREARS

RECOGNISED PROVIDERS

BENEFIT REPLACEMENT PERIOD

A policy holder who fails to pay

Queensland Country will only pay benefits

A Benefit Replacement Period applies

contributions within 63 days of the day of

for ancillary, dental and nursing services

to certain mechanical appliances and

which contributions were due and payable

where the services are provided by

hearing aids. This means that, once you

shall be deemed to be un-financial. No

practitioners recognised by Queensland

have been paid a benefit for a particular

benefits are payable for services rendered

Country. Recognition is subject to change

aid, you must wait for a certain period of

whilst a membership remains in arrears.

without notice. There are no benefits

time from the date of purchase of the

Approved psychiatric treatment

However, provided contributions are

payable for overseas hospitalisation or

item before you are entitled to a benefit

Approved rehabilitation treatment

paid within 63 days of the due date,

ancillary care.

for the replacement of that item. These

2 months Hospital: For all hospital treatments or services where there are no Pre-existing Conditions (excluding Accidental Injury^)

Dental: Diagnostic — includes examinations & consultations Preventative — includes cleaning and scaling, fluoride treatment, mouth guards etc.

Simple extraction Restorative — composite and amalgam fillings General services — includes occlusal splints Optical Acupuncture

For those of you who are thinking of starting a family, if you have a single policy, to be sure your baby has cover, it is necessary to add a newborn baby to your policy within two months after their date of birth.

The baby will not have to serve any waiting periods* that have already been fully served by the policy holder providing that the change is made to the policy within this time frame.

existing condition waiting periods may apply to the

Pre-existing Conditions

the membership will be re-instated.

Palliative care

Audiology

*For policy holders with no previous cover, the pre-

12 months

Membership of Queensland Country Elective Surgery Obstetrics-related Services Child birth education Major Dental services: Periodontics — specialised gum treatment Surgical Extraction — includes wisdom tooth extraction Endodontic Services — includes root canal therapy Crowns and Bridges Prosthodontics — Dentures

Health shall automatically cease for any policy holder whose contributions are more

Recognition of providers is for the purpose of determining the payment

Benefit Replacement Periods apply per Member.

of benefits and should not be taken or considered in any way as approval

BENEFIT

of, or any recommendation as to the

REPLACEMENT

LENGTH OF STAY

qualifications and skills of, or services

PERIOD

Full hospital benefits are not

Members should check with Queensland

available after 35 days of continuous

Country that their practitioner is

hospitalisation unless your doctor certifies

recognised before commencing

the need for continued hospital-level care.

treatment.

OVERSEAS SUSPENSION OF MEMBERSHIP

COOLING OFF PERIOD

If you’re lucky enough to travel overseas,

claim to cancel their policy and receive

and you’re going to be absent from

a full refund of any premiums paid

than 63 days in arrears.

provided by, a practitioner or therapist.

Queensland Country will allow any Member who has not yet made a

Chiropractor

Mechanical Aids & Appliances

Massage Therapy

Surgery for assisted fertility programs such as IVF or GIFT, sterilization or vasectomy, elective surgery

Australia for more than 4 weeks and less

within a period of 30 days from the

than 24 months, and provided you’ve

commencement of their policy or

fulfilled all other criteria, you may apply for

upgraded policy.

Osteopathy

Mammograms & Bone Density Tests

(For further information, please call us

Naturopath

Hearing Aids

when you’re making your travel plans.)

Dietician

Australian Hearing Services

Foot Orthoses & Orthopedic Shoes

Nursing Home Type Patients

Occupational Therapy

Nursing

Orthoptic Therapy

Hospital Boarder

a suspension on your membership.

INFORMATION

ITEMS Blood glucose monitors — (Glucometer) Blood Pressure Monitor C-pap

3 years

Machine and Humidifier and initial mask and tubing Tens Machine — (not circulation booster) Hearing Aids

Please ensure that you read all documentation provided to you before

If you develop a condition or ailment during

any decision is made to purchase a health

the suspension, you won’t be covered by

insurance product and ensure you retain

your policy. Once you re-activate your

a copy of the documentation for future

policy pre-existing condition waiting

reference.

baby within the first 12 months.

Physiotherapy

periods for that condition will apply. For

If you want to change your existing level of Extras cover for one that is more extensive you will be required to serve waits on the increased benefits only.

Exercise Physiology

information on pre-existing conditions,

Podiatry

please see page 36.

Psychology Speech Therapy Pharmaceutical School and Sporting Accidents Healthy Living Benefits ^The 2 month Waiting Period is waived for treatment arising from an accident (excluding a school and sporting accident) that occurred after joining.

[ 38 ]

[ 39 ]

GOVE R N M E NT I N ITIATIVE S AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE

LIFETIME HEALTH COVER

MEDICARE LEVY SURCHARGE

Lifetime Health cover (LHC) is a Federal Government initiative

The Medicare Levy Surcharge (MLS) is levied on payers of

The Federal Government rebate scheme was introduced in

that came into effect on 1 July 2000. It is designed to reward

Australian tax who do not have hospital cover under a private

January 1999. The basis for the initiative was to provide a

people who join a private health fund earlier in life by securing

health insurance policy and who earn above a certain income.

The Medicare Levy Surcharge is applied

financial incentive to assist Australians in affording private health

lower premium payments.

The surcharge aims to encourage individuals to take out private

on a pro-rata basis. If you take out hospital

insurance cover.

Under Lifetime Health cover, if you don’t have hospital cover on

The scheme, now known as the Australian Government Rebate

the 1st of July following your 31st birthday, then for each year you

on private health insurance introduced means testing of the

delay joining, your membership fees will increase. In fact you will

rebate in 2012, which resulted in the rebate entitlement being

pay a loading of 2% on top of the base rate on your premium (or

determined by both income* and age.

on your share of a couple or family premium) up to a maximum

This change resulted in person/s on higher incomes having their rebate entitlement either reduced, or depending on their income*, have no entitlement to receive any rebate assistance at all.

It is the responsibility of a Member to nominate an appropriate rebate tier (based on age and income*). For current financial year income thresholds refer to table over page.

loading of 70%. Once you have stayed with private hospital cover for 10 continuous years and keep it, you stop paying that loading as a reward for commitment to the private health system. Be aware that the loading may be reapplied if you then cease to hold

continuous increase and your loading will be frozen at the rate

will apply to the base hospital premium only and will not apply

Age at Entry or CAE). As long as you maintain your hospital cover,

to the portion of hospital premium that has any Lifetime Health

your loading percentage will continue to be set according to your

Cover Loading applied. (See Lifetime Health Cover section for

CAE, and will not increase each year. People who took out and maintained a hospital cover dated prior to 1 July 2000 will pay a

A Member can choose to claim the appropriate rebate up front

base rate premium regardless of their age.

as a lower premium; however can also nominate to claim a lower

People born before 1 July 1934 can take out hospital cover at

reconcile this when lodging their annual tax return.

The Australian Government Rebate on private health insurance underwent further changes in April 2014. The rebate eligibility is now based on a Member’s age and income* and will be indexed

who has a hospital cover.

hospital cover, and where possible, to use the private hospital

cover part-way through the financial year you’ll still avoid the

system to reduce the demand on the public health care system.

surcharge but only for the period you held hospital cover.

People who don’t have private health insurance hospital cover,

For current income thresholds refer to table below.

and who have an income for MLS purposes^ in excess of the thresholds set down by the Australian Taxation Office (ATO) pay a surcharge of between 1.0% to 1.5% of income . This ^

^ This information is intended as a guide only and does not take into account your personal circumstances. There is a different income test for the application of MLS, which is known as income for Medicare levy surcharge purposes. For more information about what is included

surcharge is in addition to the standard Medicare Levy of 2%

as income for Medicare levy surcharge purposes, please seek the advice of your tax agent or

of taxable income.

Accountant or contact the Australian Taxation Office (ATO) Help Line on 13 28 62 or visit the ATO website www.ato.gov.au.

By joining hospital cover as soon as possible, you can stop this that matched your age when you joined (known as your Certified

rebate than their entitlement, or in fact no rebate at all, and

to any Queensland Country policy holder

a hospital cover and subsequently take it up again.

The Australian Government Rebate on private health insurance

further information).

The Medicare Levy Surcharge will not apply

AUSTRALIAN GOVERNMENT REBATE ON PRIVATE HEALTH INSURANCE REBATE TIER

BASE TIER

TIER 1

TIER 2

TIER 3

SINGLES

Income Threshold (2015/16 financial year)

UP TO $ 90,000

$ 90,001-105,000

$105,001-$140,000

$ 140,001 AND ABOVE

FAMILIES

Income Threshold (2015/16 financial year)

UP TO $ 180,000

$ 180,001-210,000

$210,001-$280,000

$ 280,001 AND ABOVE

R E BATE E NTITLE M E NT^ BAS E D O N AG E (O F TH E O LD E ST P E R S O N O N YO U R C OVE R) AN D I N COM E*

< AGE 65

27.820%

18.547%

9.273%

0%

AGE 65-69

32.457%

23.184%

13.910%

0%

make sure you use your CAE (the age at which you joined), rather

AGE 70+

37.094%

27.820%

18.547%

0%

than the age you are now, to calculate the correct fee.

MEDICARE LEVY SURCHARGE

0%

1%

1.25%

1.50%

any time and pay only the base rate.

When transferring hospital cover from another registered fund,

by CPI (Consumer Price Index). Essentially this will mean that

Under the Federal Government’s Lifetime Health Cover legislation

the standard rebate amounts that have historically applied will be

the loading of 2% does not apply to Extras cover.

indexed each year using a ratio of the average industry premium

Note: Due to the Australian Government’s rounding rules for the

increases and CPI.

rebate, actual premiums for hospital and/or extras coverage can

Premiums quoted by the Fund will take into consideration

vary from this calculation by up to 10 cents.

Rebate percentages shown are equivalent to the actual rebate entitlement and are effective for payments made from 1 April 2015 and are indexed annually. his information is intended as a guide only and does not take into account your personal circumstances. For information on the income including the calculation method for this income known T as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 862 or visit their website at http://www.ato.gov.au/Calculators-and-tools/Income-for-Medicare-levy-surcharge/

these latest changes and will not require additional input or calculation by our Members apart from the standard age and income* information.

* This information is intended as a guide only and does not take into account your personal circumstances. For information on the Rebate including the calculation method for this income known as income for Medicare Levy Surcharge purposes, please seek the advice of your tax agent, financial advisor or contact the Australian Taxation Office (ATO) Help Line on 132 862 or visit their website at http://www.ato.gov.au/Calculators-and-tools/Income-for-Medicare-levy-surcharge/

[ 40 ]

[ 41 ]

PHARMACEUTICAL

SUMMARY OF RULES

The Pharmaceutical Benefits Scheme (PBS) is a national pharmaceutical

The “In more detail” pages contain only a

scheme funded by the Federal Government where patients contribute to the

summary of the fund rules. The complete

cost of prescribed drugs.

rules of the health benefits fund set

Queensland Country doesn’t cover pharmaceutical prescriptions covered by the Pharmaceutical Benefits Scheme or for contraceptives and items normally available without prescriptions.

We’ll pay benefits as outlined in the Extras table up to the claim limit for this category, with consideration to the maximum individual script benefit limit.

The benefit amount per script is calculated by deducting the PBS General

out in full the terms and conditions of membership and liability under the fund.

These rules are available for inspection at Queensland Country Centre, Level 1, 333 Ross River Road, Aitkenvale QLD 4814.

Patient Contribution amount from the purchase price (up to script benefit limit). This is conditional on the pharmaceutical prescription being listed in the MIMs Schedule as S4 or S8 and being dispensed in quantities in accordance with this schedule. We also pay for compound pharmacy scripts, as long as one of the ingredients meets this criteria. The PBS General Patient Contribution amount is reviewed annually by the Government and changes every year on 1 January. As at 1 January 2015, the PBS contribution is set at $37.70.

It’s important to note that a doctor’s letter may be required for some Pharmacy items.

PRIVATE HEALTH INSURANCE CODE OF CONDUCT Queensland Country Health is a signatory to the Private Health Insurance Code of Conduct. The code was developed by the health insurance industry and aims to promote the standards of service to be applied throughout the industry.

A full copy of the Code is available at www.privatehealth.com.au/codeofconduct

[ 42 ]

[ 43 ]

PRIVATE HEALTH INSURANCE COMPLAINTS

If, for any reason, you’re not happy with something then please let us know.

We will do whatever we can to fix it.

While we are absolutely committed to providing you with the best possible service, we are only human and sometimes we may make mistakes or see things differently from our policy holders, so we have processes in place to make sure you’re absolutely satisfied.

If you have any complaints, and we hope you don’t, then please contact us immediately Call:

1800 813 415

Website:

www.qldcountryhealth.com.au

Email:

info@qchfund.com.au

Address:

Queensland Country Centre

Level 1, 333 Ross River Road

Aitkenvale, QLD 4814

We take all complaints very seriously and our understanding staff are here to answer any questions and allay any fears you may have. Your health and wellbeing is our number one priority and if you’re not completely happy with our service we would like to know about it.

If, after we’ve done all we can to rectify the situation, and you’re not satisfied with the outcome, you have every right to contact the Private Health Insurance Ombudsman. The Ombudsman is an independent body formed to help resolve complaints and to provide advice and information to members of private health funds. You can contact the Ombudsman directly at: Telephone:

1800 640 695

Email:

phio.info@ombudsman.gov.au

Website:

www.phio.org.au

Address:

Private Health Insurance Ombudsman

Commonwealth Ombudsman

GPO Box 442

Canberra, ACT 2601

Australia

PRIVACY POLICY We at Queensland Country are committed to managing personal information in accordance with our Privacy Policy.

Our Privacy Policy is available for your information on our website at www.qldcountryhealth.com.au, or from any of our Retail Centres or Queensland Country Credit Union branches.

[ 45 ]

QU E E N S LAN D COU NTRY H EALTH FU N D Townsville Contact Centre: 1800 813 415 Email: info@qchfund.com.au Web: qldcountryhealth.com.au HEAD OFFICE Queensland Country Centre, Level 1 333 Ross River Road Aitkenvale Qld 4814 Phone: 07 4412 3500 Fax: 07 4412 3500 Post:

PO Box 42 Aitkenvale Qld 4814

AITKENVALE RETAIL CENTRE Queensland Country Centre 333 Ross River Road WILLOWS RETAIL CENTRE Willows Shopping Centre Kirwan

MOUNT ISA RETAIL CENTRE 70 Camooweal Street Mount Isa BURDEKIN RETAIL CENTRE 186 Queen Street Ayr MACKAY RETAIL CENTRE Caneland Central Shopping Centre QUEENSLAND COUNTRY DENTAL Queensland Country Centre 333 Ross River Road Aitkenvale

QU E E N S LAN D COU NTRY CR E D IT U N ION BEAUDESERT Beaudesert Fair Shopping Centre BOWEN 37 Williams Street BRISBANE Koala House Cnr Creek & Adelaide Street BURDEKIN Ayr - 186 Queen Street Home Hill - 6 Eighth Avenue CAIRNS Smithfield - Smithfield Shopping Centre Earlville - 514â&#x20AC;&#x201C;516 Mulgrave Road CHARTERS TOWERS Town Plaza Shopping Centre COLLINSVILLE 13 Stanley Street JIMBOOMBA Jimboomba Shopping Centre

MACKAY Caneland Central Shopping Centre Mount Pleasant Shopping Centre MOUNT ISA 70 Camooweal Street STANTHORPE 3 Maryland Street TIERI Tieri Shopping Centre TOWNSVILLE Aitkenvale - Queensland Country Centre, 333 Ross River Road Deeragun - Deeragun Village The Townsville Hospital - Main Foyer, Douglas Magnetic Island, Nelly Bay Kirwan - Willows Shopping Centre WEIPA Cnr Kerr Point Drive & Commercial Avenue

HOW TO JOI N It’s super easy to join Queensland Country Health Fund.

Call us on 1800 813 415 and complete an application over the phone

Visit a retail centre and let one of our friendly staff assist you

Go to our website and apply online through our online application process. The web address is www.qldcountryhealth.com.au

Drop in to one of Queensland Country Credit Union’s

21 branches throughout Queensland

Queensland Country Health Fund Ltd ABN 18 085 048 237 is a Registered Private Health Insurer.